The "Childmyths" blog is a spin-off of Jean Mercer's book "Thinking Critically About Child Development: Examining Myths & Misunderstandings"(Sage, 2015; third edition). The blog focuses on parsing mistaken beliefs that can influence people's decisions about childrearing-- for example, beliefs about day care, about punishment, about child psychotherapies, and about adoption.
See also http://thestudyofnonsense.blogspot.com

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Thursday, April 5, 2018

Adverse Childhood Experiences: A Helpful or a Harmful Idea?

There’s a great deal of discussion nowadays about
adverse childhood experiences (ACEs), as defined by a study in the late ‘90s
which interviewed thousands of adults and reported associations between their
adult physical and mental health and their early experiences of events like
abusive treatment or family conflict (see www.cdc.gov/violenceprevention/acestudy/index.html
for much more explanation). Many people have experienced one or two ACEs during
their childhood years, but the study reported a positive correlation between
having large numbers of ACEs in one’s history and having illness or premature
death in adulthood. The ACE study positioned adverse childhood experiences as
important factors for public health, and prevention of those experiences as a way
to improve adult health in the future.

The adverse childhood experiences studied were not on
the whole events that would directly affect health—that is, most of them did
not involve physical injury to the child or even failure to provide medical
care when needed. The ACE events could be, but most often were not, actual
traumas, catastrophic situations in which death or serious injury were feared.
The association with later health problems was surprising for those reasons,
and it has been argued that the ACEs studied may be proxy measures for other
unmeasured events that are the actual cause of later health problems. For
example, one of the original questions had to do with whether a person had in
childhood or adolescence been sexually approached by someone 5 or more years
older. Such an experience might or might not be disturbing—in fact, it might be
flattering and pleasurable for a 14-year-old girl to be in a sexual relationship
with an admired young man of 20—but the existence of such a sexual experience
might indicate parental neglect and lack of supervision, which in turn could be
the actual cause of various psychological and physical health effects.

The ACE questionnaire was intended as a “quick and
dirty” measure of childhood experiences as recalled and reported by adults.
Retrospective studies of this kind are sometimes the best that can be managed,
but they are subject to all kinds of obvious problems; people may not remember
what happened, or may remember something that did not happen, or may conceal an
event out of embarrassment, or may invent some shocking story to impress the
interviewer. Without some way to validate the reports, it seems much more accurate
to say that the people’s reports of childhood experiences are correlated with
their adult health, rather than to say that the experiences themselves are
correlated with health.

It’s certainly possible at this point to criticize the
ACE study because it did not achieve goals that were never part of the study
plan. The study did not try to identify which ACEs had the biggest effect, or
whether one of the experiences had the same effect as another. It did not look
at interactions between the individual’s developmental age at the time of the
experience and the experience itself—for example, a sexual experience with a
person at least 5 years older would presumably have a different effect when the
pair involved a 7-year-old and a 2-year-old, than when the pair were the
14-year-old and the 20-year-old mentioned earlier. It will be important someday
to know about these issues, of course, but we can’t demand this information of
research that considered only the number of adverse events experienced in
childhood and adolescence, and how that number went statistically with physical
and mental health disorders in adulthood.

Information about ACEs has been helpful in that it has
directed much attention to preventable adverse events experienced by children.
This has been persuasive because authorities and funding agencies can be convinced
to invest in resources for families when they see a benefit to public health
and its associated costs , but are less likely to do so simply because children
are miserable and failing in school or bound for the school-to-prison pipeline.
This is a bit like the attention paid to
mental illness when it is called a “brain
disorder” (which of course it is, in a sense, but hardly the same as a seizure
disorder), but not when it is regarded as an unhappy state that the patient
could rise above if he or she had some gumption.

But while helpful, ACEs scores can be scary too, when they
are misused. It’s important to keep in mind that although an individual child’s
high ACEs score is a good reminder to us that help is needed for the family,
that score is not a predictor for that child’s life. ACEs scores help us
predict events for populations—large numbers of people—but not for individuals.
Individuals may display greater or less resilience or vulnerability to adverse
events, may experience the events at different ages, and may or may not have
sources of support and buffering that protect them from poor physical and
mental health consequences. For adults, by the way, a high ACEs score can be
frightening when we think about it, but it’s important to realize that many
other factors influence health, and some of those are under our control.

A recent discussion on a psychology list revealed that
a potentially harmful forensic use of the ACE score seems to be coming into play
in legal arguments and decisions. Sentencing often takes into account the
probability that a person will repeat a crime in the future, and some are
arguing that criminals with high ACE scores are likely to be mentally ill and
therefore to have a high probability of re-offending, so they should have lengthy
sentences. This is a particularly bad example of trying to use the score to
predict an individual’s behavior when the original work had to do with what
happened to a population.

About Me https://en.wikipedia.org/wiki/Jean_Mercer

Jean Mercer has a Ph.D in Psychology from Brandeis University, earned when that institution was 20 years old (you do the math). She is Professor Emerita of Psychology at Richard Stockton College, where for many years she taught developmental psychology, research methods, perception, and history of psychology. Since about 2000 her focus has been on potentially dangerous child psychotherapies, and she has published several related books and a number of articles in professional journals.
Her CV can be seen at http://childmyths.blogspot.com/2009/12/curriculum-vitae-jean.mercer-richard.html.